And the Decision Hinges On?

[billroper]

I got a call from my doctor's office today. Apparently, my health insurance provider is claiming that they don't cover things like hinged knee braces, despite the fact that I have three torn ligaments in my knee.

I've spoken to the HR guy in our office; he's working on it. Since this brace would apparently cost about $1300, I'm rather interested in hearing about the result.

Comments

[catalana.livejournal.com]

Okay, could we please stop channelling each other? I fell on my left knee today (very gently and I'm doing fine) and now you're having insurance problems. Could this stop now, please?

[phillip2637.livejournal.com]

They're pickin up bad vibrations
They're sharing their aggravations
...

Hmmm...not as "Brian Wilson" as one might hope. :-)

[mbumby.livejournal.com]

Ouch. Hope that works out well. (Sometimes one just must do the right thing and insurance-be-d***ed, though. Two years ago, my Primary Care **10* told me that chiropractic was covered, and when I got to the chiropractor it turned out that it wasn't, but I was in sufficient discomfort, lacking sufficient mobility, that I had him "just do me" anyhow. Some say he can't possibly be helping me, but I have a lot less pain now. And I just got a crown on a tooth -- my insurance paid something like $23 of the over-800. Ouch. (Thank Ghu for Discover!) But when they were in there working he commented on the great number of cracks he uncovered. So I guess it's a good thing he was doing it then. If his not-unbiased testimony can be trusted.)

How specialized are these hinged knee braces? Is there a market for a lightly used one, or is it a friend for life? And would you consider a used one if it were available-and-cheaper? Can they be rented? Borrowed?

[shannachie.livejournal.com]

Dear me. Is there a possibility to rent the device for the time you need it? I know in Germany one can rent crutches and all kinds of stuff one needs only for a limited space of time.

[unkbar.livejournal.com]

$1300 seems awfully high. A quick look at eBay shows a lot of brand new hinged knee braces going for under twenty dollars. How much better can a $1300 brace be?

Perhaps your insurance company knows what it's doing.

Good point

[capplor.livejournal.com]

A lot of 'medical devices' are tremendously overpriced compared to what they really are, due to the economics of supply and demand and the fact that the people using them are usually desparate to get them FAST.

I still haven't gotten over the story about the gentleman who used an $8 toy instead of a multi-thousand "artificial larynx" to talk with.

[shrewreader.livejournal.com]

I'd think the insurance company is on to something -- except that they frequently pay for -casts,- which do less and cost more....

[daisy-knotwise.livejournal.com]

The trick is getting one that fits and that supports in all the right places. The right places are going to change depending on each individual leg and injury.

Roper's injury is quite severe and even if he weighed less, he still is a big guy. The largest off the shelf brace (which would be inadequate given his injury) didn't come near going over his size 13 foot.

GHR

[filkertom.livejournal.com]

What he and mbumby said. I just found out the other day that replacing my CPAP machine will not cost me the thousands my insurance had to pay a few years ago, but less than $300. See if you can get the brace from a manufacturer, or at least an online medical supplier.

[tigertoy.livejournal.com]

It's standard medical industry practice for medical devices to be insanely expensive and for insurance to not cover them (or only cover a fraction of the cost). A few months ago I got shoe inserts to help with my plantar fasciitis. Just lumps of hard molded plastic, and the only customization was by shoe size, yet they cost $60 and I had to pay it myself. The knee brace is the same deal, just with more zeroes. For $1300, it's worth some effort to find a better answer than just paying for it yourself -- for $60, I just grumbled and paid. But in both cases, somebody is getting rich preying on people who have limited options.

Good luck to you.

[orangemike.livejournal.com]

'Splain to me again how this country has the best medical care system in the world?

[tigertoy.livejournal.com]

Only if you have so much money that you don't care about something like a $1300 knee brace. Not very many people like that -- but they run the place.

[robin-june.livejournal.com]

Don't you know that everyone who wants to travel must have a Cadillac to do so?
If you can't afford a Caddie, you shouldn't use a Chevrolet, or even take the bus.

It tees me off that the business I got into (medical research) is being used for Cadillacs for the elect instead of improvements for all of humankind.

[jcbemis.livejournal.com]

I've also got three torn ligaments. We should have compared nores at GAFilk.(Bit I went from pins to "knee immobilizer" velcro from upper thigh to just above velcro; the hinged knee brace is for Post surgery, hopefully March 7.